Rheumatic Manifestations of Endocrine Diseases

Joseph A. Markenson

Disclosures

Curr Opin Rheumatol. 2010;22(1):64-71. 

In This Article

Addison's Disease

Patients with this syndrome are rare and often are difficult to diagnose. Symptoms include weight loss, myalgia, fatigue, abdominal pain, nausea, hyperpigmentation, and hypotension. Addison's disease associated with connective tissue is also rare and in contrast to older studies in which tuberculosis was the main cause, autoimmunity now is primary.[73••]

In 48 patients with RA treated for 2 years with infliximab and etanercept increased dehydroepiandrosterone sulfate (DHEAS) levels with normal ACTH, cortisol, luteinizing hormone (LH), estradiol, and testosterone were found. These results were interpreted as markers of improved adrenal function resulting from decreased inflammatory activity with treatment. In addition improved physical function was also correlated with DHEAS levels also postulated as related to improved adrenal function secondary to decreased inflammatory activity.[74]

Muscoskeletal complaints during an adrenal crisis can manifest as painful flexion contractures at the hips and knees which resolve with fluid and corticosteroid administration.[75] More common is iatrogenic Addison's resulting from abrupt withdrawal of exogenous steroids when patients can present with overt and sudden hypotension salt wasting and hyperkalemia. Treatment is somewhat controversial;[76••,77] however, in this authors' opinion necessary. Administration of stress doses of steroids (60 mg of intravenous prednisone equivalent in the first 24 h and tapering to the patients usual dose afterwards).[78] Anyone on 5 mg/day of oral prednisone or later should be considered to have a pituitary-adrenal axis unable to respond to stress.

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